2023-10-20 20:16:00
FRIDAY, Oct. 20, 2023 (HealthDay News) — When the pandemic hit, Dr. Anthony Fauci saw his “worst nightmare” materialize. Now, a different concern keeps him awake at night: that humanity will forget the lessons learned.
That’s the gist of a new editorial written by Fauci, who became a household name in 2020 after quietly leading the US National Institutes of Allergy and Infectious Diseases for nearly four decades.
Those years saw many challenges, including the HIV/AIDS crisis. However, what persistently kept him awake at night, Fauci says, was the threat of a deadly pandemic caused by an airborne virus. When that threat became a reality in 2020, that was the “nightmare.”
Now a professor at Georgetown University in Washington, D.C., Fauci no longer has “pandemic response” as a job responsibility. But he’s still thinking about the next pandemic, which is a question of “when,” not “if.”
Writing in the Oct. 18 issue of the journal Science Translational Medicine, Fauci outlines some critical lessons from the U.S. pandemic response and divides them into two “categories.”
One is the “scientific category,” which contains the big success story of the pandemic: the rapid development of vaccines that greatly reduced the risk of severe COVID infection. In more than two years, vaccination saved an estimated 3.2 million American lives, according to an analysis by the nonprofit Commonwealth Fund.
Then, Fauci writes, there is the “public health category.” That’s a mixed category, at best. Vulnerabilities revealed
The United States struggled in the public health arena, with the pandemic amplifying persistent problems such as hospital staff shortages; years of reduced funding for the public health system, which hampered efforts to track COVID cases, conduct contact tracing, and more; and racial disparities in the American health care system. It is well known that Black Americans were especially hard hit by the pandemic, said Dr. Joseph Betancourt, president of the Commonwealth Fund.
Before taking on that role nearly a year ago, Betancourt was at Massachusetts General Brigham, where he helped lead the health system’s response to the pandemic.
He said one of the biggest lessons from all of this is the need to focus on vulnerable communities. This includes “essential workers” who cannot work from home and often rely on public transportation or live in crowded housing that encourages the spread of respiratory infections.
Quick and decisive action must be taken, Betancourt said, to limit the spread of disease in communities, “where the fire is,” and not just in hospitals and other health care settings.
“Vulnerable people always suffer more during a natural disaster, including a pandemic,” Betancourt said. If a new pandemic virus emerged this winter, would the United States be better prepared this time? “To a certain extent,” Betancourt said. “But I’m still worried.”
A key to preparedness, he said, will be global infectious disease surveillance, to detect “what’s coming” before being overwhelmed by it.
Another key piece will be communication and coordination between public health departments, which in the United States are dispersed at the federal, state and local levels. “In Massachusetts, where I worked,” Betancourt noted, “every city had its own public health department.”
Then there is the big challenge of providing clear information to the public in real time and trying to counter “misinformation.”
“All the best scientific knowledge in the world means nothing,” Betancourt said, if you fail to communicate it correctly.
Public health officials, he noted, sent mixed messages on issues such as mask-wearing, which was at first discouraged and then encouraged.
During a pandemic, where scientists and health officials are trying to understand a new virus and follow a rapidly evolving situation, the “current” understanding will change over time. And the people who communicate that information, Betancourt said, must be clear about it.
“I think we need to have a sense of humility, keep things simple and be clear, ‘I’m telling you what we know right now,'” Betancourt said.
“Poor communication in public health,” he added, “creates fertile ground for misinformation. It is food for conspiracy theories.”
And even people disinclined to believe such theories can become frustrated with confusing messages. “There can be a feeling of ‘They’re telling us what to do, and they’re not even right,'” Betancourt said.
One way to address misinformation, and direct misinformation, is by involving “trusted messengers,” Betancourt said. Those are leaders in local communities who can help spread reliable public health information. It is a countermeasure on the ground against the messages that spread like wildfire on social networks.
“And that communication system needs to be built now,” Betancourt said.
Politics dirty the message
Fauci also noted that misinformation is “the enemy of the public good,” not only in the United States but in many countries. However, he added that the United States had a “deep degree of political division” that interfered with the public health response to COVID.
Now, Fauci said, the main challenge is to clearly see the lessons of COVID and remember them. “Over and over again, after time has passed since the emergence of an acute public health challenge, and after cases, hospitalizations, and deaths fall to an ‘acceptable’ level…the transition from being reactive to waning challenge to being durably and consistently prepared for the next challenge appears to be fading,” he wrote in his editorial.
“Let us hope that the collective memory of COVID-19 endures and sparks sustained interest and support in both the scientific and public health arenas,” Fauci wrote. “If not, many of us will spend a lot of time awake in bed or having nightmares while sleeping.”
“There are so many lessons here,” Betancourt agreed. “We have to make sure they are maintained. The simplest point here is: do you want to go through that again?”
More information
The US Department of Homeland Security has more information on pandemic preparedness.
SOURCES: Joseph Betancourt, MD, MPH, chairman, Commonwealth Fund, New York City; Science Translational Medicine, October 18, 2023, online.
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